Department of Obstetrics, Gynecology, and Women's Health, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.
Child Health Research Institute, Department of Child Health, University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.
Clin Infect Dis. 2022 Feb 11;74(3):467-471. doi: 10.1093/cid/ciab441.
Pregnancy has been reported to be a risk factor for severe COVID-19. We evaluated the impact of pregnancy on severe COVID-19 and mortality in an electronic medical record (EMR) database that enabled exclusion of labor and delivery (L&D) encounters.
In this retrospective cohort study, EMRs from 82 healthcare facilities in the Cerner COVID-19 Datamart were analyzed. The study comprised 38 106 individuals aged 18-45 years old with COVID-19 who had emergency department, urgent care, or inpatient encounters from December 2019 to September 2020. Subgroups were balanced through propensity score weights for age, race, smoking status, and number of comorbidities. The primary outcome was COVID-19-related mortality; secondary outcomes were markers of severe COVID-19: intubations, mechanical ventilation, use of vasopressors, diagnosis of sepsis, and diagnosis of acute respiratory distress syndrome.
In comparing pregnant and nonpregnant women, no statistical differences were found for markers of severe COVID-19, after adjusting for age, smoking, race, and comorbidities. The adjusted odds of an inpatient encounter were higher for pregnant vs nonpregnant women (adjusted odds ratio [aOR], 13.2; 95% confidence interval [CI], 11.6-15.3; P < .001), but notably lower after excluding L&D encounters (aOR, 2.3; 95% CI, 1.89-2.88; P < .001). In comparison to women without L&D encounters, hospitalization was significantly more likely for men.
We did not find an increased risk of severe COVID-19 or mortality in pregnancy. Hospitalization does not necessarily indicate severe COVID-19 in pregnancy, as half of pregnant patients with COVID-19 were admitted for L&D encounters in this study.
已有报道称妊娠是 COVID-19 重症的危险因素。我们评估了妊娠对电子病历（EMR）数据库中 COVID-19 重症和死亡率的影响，该数据库可排除分娩（L&D）就诊。
在这项回顾性队列研究中，分析了 Cerner COVID-19 Datamart 中 82 家医疗机构的 EMR。研究纳入了 2019 年 12 月至 2020 年 9 月期间因急诊科、紧急护理或住院而就诊的 38106 名 18-45 岁的 COVID-19 患者。通过年龄、种族、吸烟状况和合并症数量的倾向评分权重对亚组进行平衡。主要结局为 COVID-19 相关死亡率；次要结局为 COVID-19 严重程度标志物：插管、机械通气、使用升压药、脓毒症诊断和急性呼吸窘迫综合征诊断。
在比较妊娠和非妊娠女性时，调整年龄、吸烟、种族和合并症后，妊娠和非妊娠女性的 COVID-19 严重程度标志物无统计学差异。与非妊娠女性相比，妊娠女性住院的调整优势比（aOR）更高（aOR，13.2；95%置信区间[CI]，11.6-15.3；P<0.001），但在排除 L&D 就诊后显著降低（aOR，2.3；95%CI，1.89-2.88；P<0.001）。与没有 L&D 就诊的女性相比，男性住院的可能性显著更高。
我们未发现妊娠与 COVID-19 重症或死亡率增加相关。妊娠患者住院并不一定意味着 COVID-19 重症，因为在本研究中，有一半 COVID-19 妊娠患者因 L&D 就诊而住院。
